Tiny heart repaired in historic surgery

By Kathleen Baydala/The Clarion-Ledger

JACKSON — Zavin Arellano was two weeks old when a surgeon had to open his tiny chest and work on his even tinier heart.

The results saved Zavin and made Mississippi medical history.

Zavin was born on July 21 in Laurel. Shortly after his delivery, his parents noticed something was not quite right.

“My wife noticed he was breathing hard,” said Zavin’s father, Roberto Arellano of Heidelberg. “She told one of the nurses that she thought the baby was not breathing normally.”

An examination found that Zavin had a heart defect.

“They told us he was losing oxygen. He was turning blue,” Arellano said.

Zavin was flown by helicopter to the University of Mississippi Medical Center in Jackson, where physicians discovered his heart’s major arteries were reversed so fresh, red blood wasn’t reaching much of his body.

The surgery, performed on Aug. 4 by Dr. Jorge Salazar, lasted hours. Salazar and his team relocated the arteries and patched two holes in Zavin’s heart. The infant’s color began to return.

It was the first time an arterial switch had been done on an infant in Mississippi, and it was successful.

Before Salazar joining Blair E. Batson Hospital for Children in April, no hospitals in the state were equipped to handle complex surgeries on children with congenital heart defects. So, infants had to be flown to hospitals out of state — a hardship on babies and their parents.

Since April, Salazar has operated on 55 children, and now UMC anticipates performing one or more arterial switches a month.

“At least one in 1,000 births are babies who have a heart defect,” Salazar said. “And there are about 45,000 births a year in Mississippi.”

Salazar, director of Blair E. Batson’s congenital heart program, described the arterial switch surgery and follow-up care as a “carefully orchestrated dance.”

“Newborns are delicate like hummingbirds, and this is an aggressive surgery,” he said. “We were taking a baby fresh from his mother’s womb, opening his chest, stopping his heart, rearranging his heart anatomy, closing his chest, sending him to intensive care and a couple days later, he’s drinking his mother’s milk.”

The most technically challenging part of the procedure was switching the coronary arteries.

“They are a millimeter in diameter, maybe two at most, kind of like spaghetti noodles,” Salazar said.” If they kink or stretch or twist, then the heart won’t get enough blood and it will stop.”

After the surgery, Zavin spent several weeks at UMC recuperating, including many nights in the pediatric intensive care unit. He needed a ventilator, blood transfusions, dialysis and medication to regulate his heart. Catheters and tubes ran in and out of his little body. It was also the first time that UMC’s pediatric ICU team had been in charge of caring for an infant who went through an arterial switch.

“The unique thing about this was he was so fragile and vulnerable and needed so much teamwork the first night. But after, we got the reward of seeing him get so much better so fast,” said Dr. Elizabeth Christ, head of UMC’s Division of Pediatric Critical Care.

And through the recovery, Zavin’s parents were at his side.

“They were able to come back and spent most nights at his bedside,” Christ said.

Last week, Roberto Arellano and his wife, Georgianna Joe, were able to return home with Zavin. The couple’s two other children, 9-year-old Elijah and 10-year-old Gabriel, finally met their little brother.

“He’s doing good,” Arellano said. “He’s eating and sleeping. He’s doing everything like a normal kid.”

Click video to hear audio